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Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal Analysis
Author(s) -
Jeong SangWuk,
Lee Sang Kun,
Hong KeunSik,
Kim KwangKi,
Chung ChunKee,
Kim Ho
Publication year - 2005
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2005.33504.x
Subject(s) - mesial temporal lobe epilepsy , epilepsy , temporal lobe , epilepsy surgery , psychology , clinical neurology , medicine , neuroscience
Summary: Purpose: Determining long‐term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis. Methods: Two hundred twenty‐seven patients with MTLE were included in this study. The primary outcome variable was patient status 1–5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic‐regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5‐year follow‐up period were used. Results: The seizure‐free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic‐regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43–0.81], absence of secondarily generalized tonic–clonic seizure (2°GTCS; OR, 0.45; 95% CI, 0.26–0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11–5.26) were significant predictors of a good surgical outcome. Conclusions: Age at surgery, presence of 2°GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed.